Individual
DR. LEAH MCLANE COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
51 TIMBER LN, SOUTH BURLINGTON, VT 05403-5201
(802) 864-0521
(802) 864-6475
Mailing address
600 BLAIR PARK RD STE 285, WILLISTON, VT 05495-7586
(802) 288-1140
(802) 288-1144
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
042.0012834
VT
208000000X
Pediatrics Physician
7148432-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1026302
—
VT
Enumeration date
11/05/2008
Last updated
06/30/2023
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